Screening can reduce the colorectal cancer (CRC) burden but remains underutilized in primary care. In the proposed study, tailored messaging will be used to encourage FOBT and endoscopic screening in 14 primary care practices that are part of the Christiana Care Health System in Delaware. Using a quasi-experimental pretest-posttest design, we will deliver a Tailored Screening Intervention or TSI (a tailored screening kit, a tailored telephone call, and a tailored reminder letter) to patients who complete a Baseline Survey. Participants will be sent a kit containing a tailored CRC screening invitation letter and two tailored message pages that reflect their perceptions about screening FOBT and flexible sigrnoidoscopy and screening decision stage. An informational booklet on CRC screening and FOBT cards with instructions will also be included. A trained nurse educator will deliver a tailored telephone call to patients 10 days after the kit is mailed. During the call, the nurse educator will confirm receipt of mailed materials, verify current decision stage, review deliver tailored messages, determine current decision stage, encourage positive movement in decision stage, provide tailored messages keyed to decision stage, explain steps involved in FOBT and endoscopy screening, and offer to schedule endoscopy screening. For patients who do not report that they have decided to screen, the nurse educator will recommend that they discuss screening with their primary care physician. At 30 days, a tailored reminder letter will be sent to patients who have not screened or who have not scheduled screening and to their primary physician. The letter will provide current tailored messages, encourage positive movement in decision stage, and suggest physician-patient discussion of screening. An Endpoint Survey will be administered and an Endpoint Chart Audit will be conducted. Primary study aims are to: 1. Determine intervention impact on CRC screening utilization, 2. Determine intervention impact on screening decision stage, and 3. Determine intervention impact on patient perceptions about screening.